collegestudent: Need to taper off Lithium & Sertraline

[collegestudent]

My personal history is in my signature, but I'll put it here in my introduction aswell.

 

I tried three different anti-depressants from December 2012 to December 2013, to treat anxiety. The first was Celexa, the second was Zoloft and the last one was Prozac. In December 2013 I had a manic episode after being on Prozac for a month and a half. Then I stopped taking any medications for about a month. Then I had a second manic episode in February 2014. Then I visited a psychiatrist in March 2014 and was given a bipolar diagnosis (now I know it was an anti-depressant induced mania, not true bipolar disorder). So I was prescribed Lithium 900 mg in March 2014.  Then in April 2014 I started taking 50 mg Zoloft again for anxiety (along with the 900mg lithium I had just started taking). Since that time, I have spent 1.5 years at a 50mg level, 6 months at a 100mg level, 1.5 years at a 75 mg level. As of a couple months ago, I am now at the 50mg level again. (Not knowing much about withdrawal, my reduction from 100mg to 75 mg was a single 25mg reduction all at once- I survived that but didn’t recognize the withdrawal symptoms at the time, and I will not do that again! 6 months later I started a process of going from 75mg to 50mg, in 6 to 12 mg chunks. So as of May 2017, I am at the 50 mg level. And I am still taking 900mg Lithium. Luckily I have not experienced any manic behavior since the second manic episode in February 2014. But I know that Lithium withdrawal can cause mania so I know that I need to be careful not to make reductions too quickly.)

 

Now I need to figure out how to taper off BOTH Lithium and Sertraline.  My question is- how do I know what order to taper off this drug combination?

 

-Seeing as antidepressants are what triggered a manic episode in me a couple years ago, it makes sense to taper off / quit Sertraline first … and it seems like it would be best to wait to wait to taper off Lithium until I feel “stable” after quitting the antidepressants.

 

-But on the other hand, these two medications seem to have opposite effects.  Antidepressants seem to be a little bit more stimulating.  Lithium seems to be a little bit more sedating.  If I completely quit my antidepressants first, am I going to be extremely sluggish and glum (having no positive emotion)? Could the antidepressant withdrawal effects take longer to recover from in this scenario, because I’m still taking a high dose of Lithium?

 

What do you guys think about my situation- how should I proceed?  Has anyone here tapered off the lithium/antidepressant drug combination?

 

Thanks in advance for your help!

[mammaP]

Hi CS, welcome to SA.  

Your reasoning is right about tapering sertraline first, when there are multiple drugs we recommend tapering the AD first because it is activating.  Some people will taper a drug part way, then hold for a while, then taper the other drug part way and so on until bioth drugs are finished. Jan, one of our mods is expert on lithium and has successfully tapered it herself so will no doubt chime in here with her recommendations when she is here. She is very busy so it could be a while but in the meantime you can start to plan your sertraline taper.  I will get some links for you to read,, you may have seen them already but it is useful to have them at the start of your topic so you can access them easily when you need to throughout the taper. We recommend tapering 10% of the current dose with a month between cuts. This takes time but ensures a safe taper and means that withdrawal will not send you back on the drug again after stopping. 

 

Why taper 10% 

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Tips for tapering Sertraline 

http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/

 

The 3 KIS

 

http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

Tapering multiple drugs

http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-taper-the-antidepressant-first/

 

Tapering lithium

http://survivingantidepressants.org/index.php?/topic/2976-tips-for-tapering-off-lithium/#comment-36863

 

There will be links in the topics to the posts that contain the relevent information

 

Please put your drug and tapering history in your signature, we ask all new members to do this. You can find instructions here..

http://survivingantidepressants.org/index.php?/topic/12364-please-put-your-withdrawal-history-in-your-signature/

 

Edited August 2, 2017 by mammaP

[scallywag]

About the Lithium, collegestudent -- is your doctor testing you regularly for your serum levels of lithium? If not, they *%$# should be. Lithium levels need to be assessed at least twice a year.

[collegestudent]

4 hours ago, scallywag said:

About the Lithium, collegestudent -- is your doctor testing you regularly for your serum levels of lithium? If not, they *%$# should be. Lithium levels need to be assessed at least twice a year.

 

Yes, I have been having my Lithium levels tested.  I need to have them done more regularly (twice a year like you say, instead of once a year). My last lab test a couple months ago showed that I was at .5 mmol/L.  My psychatrist told me that was fairly "low" because the Lithium therapeutic range is .6 - 1.2 mmol/L, and he said it was good that I didn't need an even higher dosage. Whatever that means...